Prevention & Recovery

How to prepare for a vaginal exam

Time of the month matters The first day of your period marks the first day of your menstrual cycle, and the ideal time to get a pelvic exam is in the middle of your cycle, says Dr. Ellen Giesbrecht, MD, department head of Obstetrics and Gynecology at the BC Women's Hospital.

She recommends scheduling your appointment for a week after your period. Doctors can still do an exam if you're menstruating, but you won't get clear results on your Pap smear or on any swabs, so you'll end up having to come back. It's also best to have a breast exam after your period, when your breasts are less tender, says Dr. Giesbrecht.

Track your cycle If you're having pain or period problems, monitor your cycle for a few weeks or months leading up to your appointment and record the results. Dr. Giesbrecht recommends using a period tracking app to monitor the frequency, flow and symptoms associated with your period. Bring this information to your appointment to help your doctor identify any possible issues. (Just be mindful not to rely on the app for fertility or reproductive information, warns Dr. Giesbrecht.)

Getting screened In a typical screening, your doctor will take your blood pressure, then do an abdominal exam. Your doctor may also perform a breast exam, but this is determined on a case-by-case basis. Then comes the external pelvic exam, in which the doctor will look at the vulva for lumps, bumps and discolouration. Following that, the doctor will inspect the vagina and cervix (generally using a speculum to dilate the vagina), then do a Pap smear and swabs if necessary.

A Pap smear, which swabs the cervix for precancerous cells, should be done by your doctor every one to three years, depending on the screening guidelines of your province or territory. If you're sexually active or have other risk factors, you may require swabs and a urine test for STIs like chlamydia and gonorrhea.

The last part of the screening is a bimanual exam, in which the doctor examines you externally with one hand (on the abdomen) and internally with the other, feeling for an enlargement of the uterus or masses on the ovaries, and noting any excessive pain or tenderness.

Know your history Ask your mother or female relatives about your family's history of cancer and reproductive concerns, says Dr. Giesbrecht. This is particularly relevant when it comes to breast, ovarian, uterine or cervical cancer as well as fertility issues or pregnancy complications. This information can help your doctor determine the correct course of action if you're experiencing issues.

Ask questions "Don't be afraid to ask questions," says Dr. Giesbrecht. Sometimes doctors discover things they may not have noticed otherwise when a patient mentions something they're worried about. "The only bad question is an unasked question."

Why do you need a Pap smear? A Papanicolaou (Pap) smear is a screening test for cervical cancer. A doctor inserts a brush or spatula into the vagina to sample the cells at the opening of the cervix. The test looks for precancerous changes in these cells, one of the effects of the human papillomavirus (HPV). "Like a mammogram, it's a screening test where we can intervene early in the course of a disease to halt progression," says Dr. Giesbrecht.

HPV news About one in 145 Canadian women will develop cervical cancer in their lifetimes, and contact with cancer-causing strands of human papillomavirus (HPV) is the biggest factor in determining whether you'll be one of them. A few factors, such as smoking or having a weakened immune system, can worsen your risk, but there's one huge thing you can do to stay safe: get the HPV vaccine. Sure, condoms decrease your chances of getting HPV by reducing skin-on-skin contact, but they don't eliminate the risk.

There are two vaccines in Canada that can help protect against HPV: Cervarix and Gardasil. Both safeguard against the two strains that cause most cervical cancers, but only Gardasil protects against the strains that cause genital warts. Gardasil has been approved for use in women up to age 45, but women aren't the only ones who should consider taking it.

Since 2010, males ages nine to 26 have been eligible for the vaccine. That's because men too are vulnerable to HPV-related cancers, including anal and penile cancers, though research on whether the vaccine can prevent those is still needed. Plus, both men and women can be at risk for cancers in the mouth and throat when they contract HPV through oral sex. In fact, HPV is linked to about 25 to 35 percent of oral cancers. And remember, even vaccinated individuals need to be screened regularly.